Reduced self-esteem and depression is often present among those suffering from skin disorders and hair loss. In some instances psychological effects can be dramatic. Thus, the development of therapeutics to treat each medical condition is underway. The present invention addresses current therapies and provides new compositions that have promising results.
Acne (acne vulgaris) is a common inflammatory disease of the skin, caused by changes in the pilosebaceous units (skin structures including a hair follicle and its associated sebaceous gland) in response to sexual hormones. Acne is most often found on the face, chest and back. The condition is most common at puberty and generally tends to disappear, or decrease when the individual reaches the early twenties. However, acne can remain problematic into the third to fifth decade of life and in some instances even longer.
The basic acne lesion, called a comedo or comedone is an enlarged hair follicle plugged by excess oil secreted from the sebaceous gland in response to androgen. In addition, dead skin cells and the build up of the bacteria Propionibacterium acnes also contribute to enlarging hair follicles. P. acnes produce lipases which can split triglycerides into free fatty acids, which can irritate the follicular cells. The severity of acne can range from mild to severe. In addition to comedones, papules, pustules, nodules and inflammatory cysts are also lesions associated with acne. Non-inflamed sebaceous cysts, also called epidermoid cysts, may occur in association with inflammatory acne or alone but are not usually a constant feature. After resolution of acne, unsightly scars may remain.
Many products are available for the treatment of acne, the most popular including exfoliation products, antibiotics, topical bactericides, retinoids, and oral hormonal treatments. However each has potential drawbacks. More recently compounds capable of inducing degradation of the androgen receptor are under investigation as potential treatment for androgen receptor associated disorders.
Exfoliation either manually or chemically attempts to remove dead skins cells from the skin therefore reducing the likelihood of blocked pores. Exfoliation may be performed manually by using scrubbing products or may be performed chemically. The chemical exfoliation products salicylic acid and glycolic acid are available as a chemical peel. Exfoliation may result in flaking of the skin or irritation.
Antibiotics, either oral or topical, are commonly used to attack the bacteria P. acnes. Erythromycin, clindamycin, cotrimoxazole and numerous tetracycline derivatives (such as doxycycline, oxytetracycline, tetracycline chloride, limecyline and minocyline) are commonly prescribed as treatments for acne. Although antibiotics are effective at reducing bacterial colonies, reducing the presence of bacteria does not affect the oil secretion from the sebaceous gland, and the potential development of bacterial strains resistant to antibiotics is also a concern.
Like antibiotics, topical bactericides such as benzoyl peroxide attack bacteria Propionibacterium acnes. Although topical bactericides have the added benefit over antibiotics in that bacterial resistance is not found, the powerful oxidizer benzoyl peroxide can cause skin dryness, redness and can bleach clothing. Therefore methods to reduce the frequency of use or decreased concentrations of the powerful oxidizer would be a significant benefit over current therapies.
Retinoids such as the topical retinoids tretinoin (brand name Retin-A), adapalene (brand name Differin) and tazarotene (brand name Tazorac) are related to vitamin A and may regulate the cell cycle in the follicle lining. Topical retinoids can cause significant irritation of the skin. Oral retinoids such as the vitamin A derivative isotrenoin (brand name Accutane and Sotret) are believed to reduce oil secretion from the sebaceous gland but are also believed to have adverse side effects.
Androgenetic Alopecia is the most common form of hair loss in men. This condition is also commonly known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic “M” shape. Hair also thins at the crown of the head, often progressing to partial or complete baldness. The pattern of hair loss in women differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede. Androgenic alopecia in women rarely leads to total baldness. Minoxidil is the only FDA-approved treatment for androgenetic alopecia; however, it is not targeted at the function of androgen and effectiveness is not widespread.
Higher serum androgen levels have been correlated with the presence of acne, androgenetic alopecia and hair loss in some women. Androgens are known for their effects on sebum excretion, and terminal sebocyte differentiation is assisted by peroxisome proliferator-activated receptor ligands. Hormonal treatments have been identified as having a potential effect on acne and androgenetic alopecia. Compounds with anti-androgenic properties include estrogens combined with progestins, such as ethinyl estradiol with cyproterone acetate, chlormadinone acetate, desogestrel, drospirenone, levonogestrel, norethindrone acetate, norgestiate. Other compounds used as anti-androgens include those that directly blocking the androgen receptor (such as flutamide) or inhibit androgen activity at various levels such as corticosteroids, spironolactone, cimetidine and ketoconazole. However androgens are involved in many biological processes; therefore, blocking or inhibiting androgen binding to its corresponding receptor results in increased levels of available androgen in the surrounding environment, which affects other androgen associated biological processes and can lead to undesirable side effects.
A new group of anti-androgenic compounds have been proposed that induce degradation of the androgen receptor. These compounds differ from conventional anti-androgens that block androgen receptor and ligand (androgen) binding. Unlike widely used anti-androgen therapies, these new compounds prevent the accumulation of excess ligands (androgen) to act on androgen receptor and thus are predicted to have fewer adverse effects. Although a variety of compounds are proposed, the technology is not yet clinically available and the long term effects are not yet known.
Although the majority of treatments for skin disorders utilize a single active compound or pharmaceutical, a combination of therapies including a topical retinoid combined with oral antibiotics has been explored in mild to moderate inflammatory acne. These combinations are believed to lead to a rapid dose reduction and quicker discontinuation of oral antibiotics increasing the effectiveness and reducing the development of bacterial resistance to antibiotics. Although combinations of therapies have been proposed, current therapies attempt to reduce symptoms associated with skin disorders and do not selectively target the cause of the disorder. Therefore there remains a need to develop methods and compositions that selectively target pathways that lead to the skin disorders while also treating associated symptoms.